“Causes & Prevention of Coronary

Artery Diseases and Diabetes”

HARD HEART FACTS
U.S. CARDIO VASCULAR DEATHS =
2400 / Day
(Heart attacks, strokes, Heart Failure, other
vascular complications)

1 death every 33 seconds

= 10 Jet Crashes daily…

HEART FACTS
U.S. CVD DEATHS - 1 MILLION / YR
42% OF ALL DEATHS
BY THE YEAR 2020, #1 CAUSE OF DEATH IN
THE WORLD
HEART FAILURE UP > 100 % SINCE 1979
STROKE UP 10% SINCE 1991
COSTS / YEAR - $275 BILLION
 Cardiovascular Disease

• 1/3 of deaths under age 65

• For 25% of people their first warning is

sudden cardiac death

• Women = men especially postmenopausal

I.5 million heart attacks, 500,000 cardiac

deaths each year in the U.S.
TIME TO GET INTO YOUR
JOGGING SHOES
Prevalence of CAD in India
12

10

6
CAD
4

0
1960 (30- 1962 (30- 1968 1990 (25- 1994 (15- 2001
70 yrs) 70 yrs) (>30 yrs) 60 yrs) 64 yrs) (>20 yrs)
RISK FACTORS
Modifiable
Hypertension
Smoking
Lipids
Obesity
Non modifiable
Age
Diabetes mellitus
Family history
Ethnical issues
 NEWLY IDENTIFIED RISK
FACTORS
 Lack of exercise
 Low consumption of fruits, vegetables

 Abdominal obesity

 Stress
David Mc Lean and Wayne MC Laren
20 years later

cancer
 SMOKING
 Single most important modifiable risk factor.
Consumption of even 1-4 cigarettes daily
increase CAD risk.
 35-40% of all smoking related deaths are due to
CAD.
 Passive smoking is also harmful.
 50% risk reduction in 1 year followed by more
gradual decline to baseline at 5-15 yrs following
smoking cessation.
 Why smoking is injurious?
 Decreases HDL
 Increases fibrinogen, platelets
 Increases catecholamine
 Decreases Oxygen carrying capacity
 Decreases effectiveness of medicines
 Can cause coronary spasm

Thus smoking can lead to CAD, CVD, PVD.

 Gutkha/Pan Parag – one pouch(4 gm) Increase

in Heart Rate & BP – normalizes in 30 min.

 HYPERTENSION

 Silent killer.
 Prevalence around 30% and
 increases with age. the prevalence is increasing.
 Both systolic as well as diastolic BP is important
 A 7 mm hg increase in diastolic BP over baseline is
associated with 27% increase in CAD risk and 42%
increase in stroke risk
 Lowering diastolic BP by 5-6mm results in 15% CAD risk
reduction and 42% stroke reduction.
HYPERTENSION

Normal <120/<80 Lifestyle

modification
Pre- 120-139/80- Lifestyle
hypertension 89 modification
Stage 1 140-159/90- Drug therapy
99
stage2 >160/>100 Drug therapy
 Average Percent Reduction
Stroke incidence 35–40%

Myocardial infarction 20–25%

Heart failure 50%

 Modification Approximate SBP reduction
(range)

Weight reduction 5–20 mmHg/10 kg weight loss

Adopt DASH eating plan 8–14 mmHg

Dietary sodium 2–8 mmHg

reduction
Physical activity 4–9 mmHg

Moderation of alcohol 2–4 mmHg

consumption
DASH-fruits, vegetables, low fat diary products reduced saturated fat
Web site
www. nhlbi.nih.gov/
Dys - or Hyperlipidemia
LIPID COMPONENTS:
TC
LDL-C
HDL-C
TG
Lpa
HYPERLIPIDEMIA
A 10% increase in serum cholesterol is associated
with a 20-30% increase in cad.
Atherosclerosis starts at an early age .
The recommendations are based on NCEP
guidelines.
Current guidelines recommend measurement of
fasting total cholesterol and triglycerides once at
above 30 yrs age. if value is abnormal a full lipid
profile should be obtained
HYPERLIPIDEMIA
Frequency of repetition depends on levels and
associated risk factors.
Treatment depends on presence of diabetes,
associated risk factors and presence of CAD.
Diet and exercise form an essential part of
management in addition to drugs.
HYPERLIPIDEMIA
RISK LEVEL LDL GOAL

CAD or presence of <100 (<70)

diabetes

Multiple 2+ risk <130

factors
0-1 risk factor <160
HYPERLIPIDEMIA
PRIMARY PREVENTION GOALS

LDLc <130 mg/dl

TG <150 mg/dl
HDLc >40 (men) >50 (women)
Diabetes Mellitus & Metabolic
Syndrome
Patients with diabetes have 2-8 fold higher rates
of cardiovascular events.
75% of all deaths in diabetics occur from cad. Risk
begins to increase before onset of clinical
diabetes.
Metabolic syndrome an associated condition
characterized by lipid abnormalities (inc TG low
HDL, abnormal LDL) abdominal obesity, insulin
resistance, diabetes, hypertension, urine albumin.
DIABETES – LETHAL WEAPON
Diabetes Mellitus & Metabolic
Syndrome
NORMAL IMPAIRED DIABETES
mg/dl GLUCOSE MELLITUS
TOLERANCE
FPG<110 FPG>110<12 FPG>126
6

2 HR PG<140 2HR 2HR PG>200

PG>140<200
Diabetes Mellitus & Metabolic
Syndrome
You may have metabolic syndrome if you have
three out of following five features waist
circumference>102 cm (men) 88 cm (women)
TG level 150mg/dl or more
HDLc <40(men), <50(women)
BP 130/85 or more
Serum glucose of >110 mg/dl
OBESITY
Definition BMI-W/Hs2 (kg/m2)

Normal – 19 – 24.9
Over wt – 25 – 29.9
Obese – >30
Waist hip ratio

Optimal – 0.8
Obesity – >1.0
OBESITY
Independent marker.
Predisposes to diabetes mellitus and metabolic
syndrome.
Association with hypertension.
Associated with lipid abnormalities.
Central obesity as defined by waist hip ratio more
dangerous.
Mental Stress, Depression
Adrenergic stimulation.
Coronary vasoconstriction.
Platelet and endothelial dysfunction.
Metabolic syndrome.
Ventricular arrhythmias
Work related stress viz job strain or reward imbalance
double risk of MI and stroke. Anger & hostility are
detrimental
NEWER RISK FACTORS
Lipoprotein (a).
Homocysteine.
Tissue plasminogen activator and plasminogen
activator inhibhitor.
Fibrinogen.
High senstivity CRP.
Primary Prevention –Identification of Risk
Factors
More the number of risk factors higher the risk

Health screening at least in following subgroups

- > 40 yrs of age
- >30 yrs age with 2 or more risk
factors
- for those with strong family history or
diabetes mellitus even earlier screening
- serum cholesterol is mandatory at least
once above age 30 yrs
Primary Prevention –Interventions
Life style modification
-Control of risk factors
-Diet
-Exercise
Primary Prevention - Lifestyle
DIET: foods considered heart healthy are
fruits and vegetables three or more servings per
day reduces cardiac risk by 27%.Consumption of
five or more portions per day of a variety of fruits
and vegetables is recommended.
Whole grains and fibres contain vitamins,
phytoestrogens, phenols, omega-3 fatty acids,
resistent starch and minerals.
 Diet :continued
Legumes peas, soya, lentils, beans
Nuts 5 oz /week or at least twice a week. good
sources of monounsaturated fats, fiber, minerals,
flavanoids. walnuts are rich in pufa. Almonds have
beneficial effect on lipids.
Fish and fish oil high omega 3 fatty acids confers
protection against CAD. At least once a week
reduces cardiac mortality by 52%.ythis is
equivalent to5.5gm/month of EPA + DHA.
Salmon, mackrel, tuna, swordfish, herring,
sardines, laketrout.
DIET: continued
Alcohol moderate alcohol consumption defined as
1 -2 potions of wine (150ml) 3-4 times/week
decreases risk of CAD.
Wine is the suggested form possibly due to
content of polyphenols. Possible benefits include
improvement in lipids, better anticlotting
properties.
ALCOHOL CONSUMPTION SHOULD NOT BE
RECOMMENDED AS A MEANS OF REDUCING CAD.
Physical Activity : Exercise
American heart association guidelines advise
walking, jogging, cycling, swimming, or any other
aerobic activity for 30-60 mins on most days of the
week. Supplementary increase in daily activities
like taking stairs in place of lifts is suggested.
Strength training offers additional cardiovascular
benefits
TACKLING OBESITY
Dietary modification substituting foods with low
glycemic index.
Calorie restriction.
Low carb vs. low fat diet.
Behavioral therapy.
Structured exercise programme.
Childhood obesity should also be avoided.
TACKLING OBESITY
NCEP recommends diet 25-35% of calories from
fats ,saturated fats less than 7% of fat intake and
cholesterol less than 200mg/d. Carbohydrates should
account for 50 – 60% calories and proteins 15%. In
addition 20-30 gm of dietary fibres as well as 2 gm of
plant sterols/stanols
CONCLUSION
Prevention is better than cure.
Life-style modification is the cornerstone in
preventing CAD.
Risk factors should be detected and corrected early.
Periodic health checks help in early detection of risk
factors and their treatment.
Self Help
 No one knows YOU better than Yourself
 No one can EAT for You
 No one can LOSE WEIGHT for You
 No one can THINK for You
 No one can STOP bad habits for you
 No one can DEVELOP good habits for You
 No one can take MEDICATION for You

 No one but YOU can change yourself